Subinvolution of placental bed vessels: case report and review of the literature

Analysis on Medication Rules of Chinese Medicinal Herb Formulae in Uterine Subinvolution Treatment Based on Data Mining

Introduction

Uterine subinvolution, especially the subinvolution of the placental site, can be a life-threatening disease that induces secondary postpartum hemorrhage (PPH). Chinese Herbal Medicine has been widely used to improve postpartum recovery and treat uterine subinvolution for thousands of years. Yet, there are many potential laws hidden that are worth exploring.

Methods

Prescriptions treating uterine subinvolution were searched and collected to form datasets. Data mining methods including frequency analysis, cluster analysis, and association rule learning were performed to uncover the potent prescription laws of uterine subinvolution treatment.

Results

A total of 803 formulae involving 249 herbs were obtained. The top 6 most frequently used herbs were Angelicae Sinensis Radix (Danggui), Chuanxiong Rhizoma (Chuanxiong), Leonuri Herba (Yimucao), Persicae Semen (Taoren), Zingiberis Rhizoma Preparatum (Paojiang), and Radix Glycyrrhizae Preparata (Zhigancao). Most of the 249 herbs were being warm in properties, sweet in tastes, and mainly distributed to liver and spleen meridian tropisms. Deficiency-tonifying herbs accounted for the most proportion and heat-clearing herbs ranked the second, followed by blood-activating and stasis-eliminating herbs. 6 clusters were generated by hierarchical clustering, and 5 of them were of clinical significance. 78 rules with support values over 0.25, confidence values over 0.8, and lift values greater than 1 were generated by association rule learning.

Conclusion

The basic principles for uterine subinvolution treatment were deficiency-tonifying, heat-clearing, blood-activating, and stasis-eliminating. Herbs with warm properties, sweet tastes, and liver and spleen meridian tropisms are generally suitable. In addition, Sheng-Hua-Tang was the most frequently used formula for the treatment of uterine subinvolution, yet the dialectical prescriptions were diversified with different patterns/symptoms.

Fertility preserving management for postpartum haemorrhage secondary to subinvolution of the placental implantation site

A 40-year-old woman presents with recurrent secondary postpartum haemorrhage (PPH) following her third normal vaginal delivery. Histology from subsequent evacuation of the uterus confirmed that she had subinvolution of the placental implantation site. Hysterectomy is the most common method of managing this condition and recurrent PPH, most often due to significant vaginal bleeding. We present a case of subinvolution of the placental implantation site with recurrent PPH managed with medical treatment alone, to offer a fertility-sparing treatment option.

Subinvolution of the placental site as the cause of hysterectomy in young woman

Subinvolution of placental sites (SPSs) is a rare but severe cause of secondary postpartum haemorrhage (PPH). SPS is characterised by the abnormal persistence of large, dilated, superficially modified spiral arteries in the absence of retained products of conception. It is an important cause of morbidity and mortality of young women. In this study, we present a case of secondary PPH in a young woman after uncomplicated caesarean delivery who was deemed clinically unstable, and finally, underwent emergent total abdominal hysterectomy. We reviewed the literature with an emphasis on the pathophysiology of this situation. Treatment of patients with SPS includes conservative medical therapy, hysterectomy and fertility-sparing percutaneous embolotherapy.